In this clinical case, the lesion is approached using a microconvex probe, with a trajectory that is almost parallel to the ultrasound beam. In such a case, the needle is hardly visible with ultrasound alone.

Using Volume Navigation on the LOGIQ E9, image fusion of 2D ultrasound and PET slice of the colonic wall was possible. eTRAX Needle Tip Tracking was useful for continuous visualization of the needle tip.

The patient underwent a sensitive biopsy in a portion of the retroperitoneum. Electromagnetic needle tip tracking allowed continuous visualization of the needle pathway for safe and easy insertion into the kidney.

Patient presented with a difficult-to-see lesion using conventional ultrasound. Access was aided with image fusion and the use of eTRAX Needle Tip Tracking through a non-accoustic window. Image fusion using CT and ultrasound data sets was possible with Volume Navigation technology. Needle tip tracking was useful for continuous visualization of the needle tip.

A 62 year-old woman affected by systemic lupus erythematosus since she was 37, and taking corticosteriods, underwent abdominal ultrasound for a mild elevation of transaminases. A 30mm hypoechoic and irregular mass was detected in segment II-III and a biopsy of the mass was performed.

Patient presented with a small, superficial kidney lesion. The use of Volume Navigation on the LOGIQ E9, image fusion of ultrasound and CT was possible. Using an out-of-plane approach, eTRAX Needle Tip Tracking was useful for continuous visualization of the needle tip.

An 86 year-old-male with a history of metastatic colon cancer to the liver underwent multiple courses of chemotherapy over a period of three years. His disease was under control except for one metastasis in the dome of the liver. Despite multiple courses of chemotherapy, this hepatic lesion persisted. His oncologist exhausted all possible treatment options of chemotherapy and feared further toxicity, and unlikely benefit from further treatments.

Using the needle guide system (Ultra-Pro II, CIVCO Medical Solutions) was helpful in accessing the liver via the usual midline approach. The trajectory was taken that most closely avoided the stomach with the 52-degree angle option of the multi-angle bracket and needle guide.

The multi-angled needle guide system (Ultra-Pro II, CIVCO Medical Solutions) was utilized to plan a biopsy trajectory that included overlying normal parenchyma and also avoided prominent vessels. The multi-angle approach allowed successful biopsy of the lesion.

Patient presented with a difficult-to-see pancreatic abscess. Accurate access was aided by eTRAX Needle Tip Tracking’s projection and pathway for advancement the needle. Use of an ultrasound overlay with CT revealed the required entry point.

Using Volume Navigation on the LOGIQ E9, image fusion of 2D ultrasound and CT made it possible to visualize a difficult target. Using eTRAX Needle Tip Tracking was beneficial to obtain proper access to the obscurred target and continuously visualize the needle tip as it was advanced.

The initial image demonstrates the liver lesion 15.8cm deep to the skin line with a hepatic vein in the path of the needle trajectory. The point of entry was changed and the lesion depth decreased to 14.7cm with no large vessels in the pathway. The needle guide (Ultra-Pro II, CIVCO Medical Solutions) helped reposition the trajectory and the biopsy was successful.

This case demonstrated that monitoring of electrode tip using VirtuTRAX is feasible and helpful for thyroid RFA. The VirtuTRAX device could increase the accuracy and the outcome of thyroid RFA while reducing the complication rate, shortening the procedure time and learning curve.

Ultrasound may provide a limited view of the hip joint, as it only allows identification of joint effusion, synovitis and some tears of the labrum. This imaging technique is often useful for interventional procedures when supported by the Ultra-Pro II needle guide.

Baek Advocates Benefits of Ultrasound and Electromagnetic Tracking Technology: “In radiofrequency ablation, monitoring the electrode tip during ablation of a thyroid nodule with the VirtuTRAX™ technique is feasible and helpful to increase safety of the procedure.”

The authors compared percutaneous liver biopsy procedures performed using free-hand ultrasound-guidance to those
performed using electromagnetic needle tracking (EMT). Thirty percutaneous liver biopsies were performed using conventional
free-hand US guidance and 30 using the eTRAX™ Needle Tip Tracking system and the GE Healthcare LOGIQ E9 ultrasound system.

This study tested the hypothesis that a needle guided technique (NG) would allow faster central venous catheter placement, better success rates and fewer needle sticks than both the short-axis (S-FH) and long-axis (L-FH) free-handed methods. Additionally, the authors postulated the lack of control of needle depth under the short-axis (S-FH) approach contributes to inadvertent arterial puncture.

The authors presented a correlation study using Computed Tomography (CT) that compared the differences between using a
freehand and needle-guided ultrasound biopsy technique. The purpose was to assess the accuracy of the needle position in
relation to the target and to quantitatively characterize the time required to insert a needle to the target and the number of needle
passes required to reach the target using each technique.

In this clinical investigation, the authors conduct a study to evaluate the accuracy and safety of electromagnetic needle tracking for use during ultrasound-guided percutaneous liver biopsy. Using a 16-gauge eTRAX™ Needle Tip Tracking system as a cannula, two 18-gauge tissue cores were retrieved using an automated biopsy needle and an ultrasound system with positioning sensor technology. In total, 23 liver biopsy procedures were performed. The majority of the procedures were completed using an in-plane approach, however, the out-of-plane approach was utilized during cases deemed inconvenient or unsafe for the traditional method.

An in vivo swine study was performed to assess the overall targeting accuracy of an ultrasound system with navigation technology, electromagnetic tracking and needle sensor technology embedded within the needle tip and placed a the hub of the needle. The target accuracy of the two techniques was then compared to a free-hand technique. Metallic targets were embedded into the paraspinal muscle, kidneys and liver of the swine model. CT data sets were used in combination with real-time ultrasound imaging to evalaute the Virtual Navigator’s response to respiratory motion and targeting accuracy in a live model.

Abscess drainage under ultrasound guidance has advantages over using other imaging modalities. Real-time visualization of the area of
interest and drain placement can be accomplished within a department or portably at the patient bedside. Unfortunately, ultrasound has
limitations imaging through air-containing cavitities or behind bone. In this pictorial essay, the authors describe three patient cases where
the use of ultrasound and electromagnetic needle tracking, eTRAX™ Needle Tip Tracking System (CIVCO Medical Solutions, Kalona, IA) in
combination with image fusion (GE Healthcare LOGIQ E9, Milwaukee, WI) with CT or MRI data sets successfully treat air filled intraabdominal
cavity abscesses

In this article, the authors conducted a pre-clinical trial using a liver phantom with a corresponding CT dataset to evaluate the performance and time efficiency for performing liver interventions under US-guided image fusion using the LOGIQ™ E9 with Volume Navigation (VNAV, GE Healthcare, Chalfont St. Giles, UK) and a 16-gauge eTRAX™ needle tip tracking system (CIVCO Medical Solutions, Kalona, Iowa, USA).

A clinical study approved by the Chiba Medical Center Ethical Committee was performed to test a three-step method designed to overcome pitfalls associated with ultrasound-guided long-axis central vein catheterization (LAX-IP). Identified pitfalls of this technique include veins that curve and are challenging to approach, utilizing free-hand needling technique requires specific skills and training and lastly, identifying the true center of the view in LAX-IP is challenging with 2D imaging.

The authors conducted the first clinical, prospective, randomized trial of ultrasound-guided subclavian vein cannulation for central venous catheterization with an in-plane multi-angle needle guide (Infiniti Plus, CIVCO, Kalona, IA). This study was approved by the Ethics Committee of the Faculty of Medicine of Ruhr University, Bochum, Germany and includes analyzed results from 159 catheterizations.

Trial participants consisted of 25 anesthesiologists with more than 2 years of clinical experience and/or who received simulation training at the author’s institutions. All participants had received prior simulation-based CVC training. Simulation trial equipment consisted of: CVC simulator, SonoSite iLook ultrasound machine using the L25 (5-10 MHz) linear transducer and with the Infiniti™ Needle Guidance System (CIVCO Medical Solutions, Kalona, Iowa) attached to the transducer.

In this phantom study, the authors evaluate accuracy and time required to perform a free-hand electromagnetic needle tracked biopsy using a traditional in-plane and out-of-plane approach compared to standard needle guided technique with an attached steering device. A LOGIQ E9 ultrasound system 16-gauge eTRAX™ Needle Tip Tracking System and a semi-automatic needle was used to perform 20 in-plane and out-of-plane biopsies on a custom phantom. Time was recorded for each attempt and macroscopic investigation of the retrieved core samples determined the presence of red dye from the 1cm lesions. This process was repeated using the standard mounted needle guide technique.

One of the largest single-center studies comparing the yield and complication rate of 2,138 kidney biopsies was performed by Nephrologists in a tertiary care teaching institute in India. The patient demographic ranged from pediatric to adult and the kidney biopsy types included native, graph and transplanted organs. During the first observational period spanning April 2004 - December 2010, 1,510 ultrasound-guided biopsies were performed by Nephrologists with the imaging support of a Radiologist and without the use of a biopsy needle guide device. During the second period of evaluation, January 2011 - March 2013, 628 renal biopsies were performed solely by Nephrologists using both real-time ultrasound imaging
ultrasound systems and Ultra-Pro II™ needle guide.

To overcome two of the most significant barriers in providing a safe and efficient ultrasound-guided nerve block, a clinician must
keep the needle in the image plane and avoid unintentional probe movement while advancing the catheter. This case highlights
the use of a needle guidance system, Ultra-Pro II™, to facilitate overcoming barriers using a single operator, in-plane approach.

An ultrasound comparison experiment between the freehand and probe-guide technique was performed using a custom gelatin
and olive phantom to compare the time and quality of the biopsy sample. The participants included 3-novice, 3-intermediate and
4-experienced physicians with no prior experience using ultrasound needle guides.

Thirty anaesthetists with varying levels of experience in performing regional nerve blocks participated in a crossover simulation study approved by the Melbourne Health Human Research Ethics Committee. Utilizing a porcine phantom model simulation, this study compared ultrasound guided free-hand technique and the use of a variable angle needle guide to test the hypothesis that the needle guide method will increase the percentage of time the needle tip is visualized during a regional blockade.

The Cleveland Clinic performed a single-center, randomize, controlled trial to test the use of Infiniti Plus ™ Needle Guidance System during a femoral nerve catheter placement. The authors concluded the use of Infiniti Plus significantly decreased the median time spent performing femoral nerve catheterization by 32% compared to a free-hand technique.

In this publication, the authors report the process and outcome of a clinical study comparing the use of Infiniti™ needle guide (CIVCO, Kalona, IA) and the free-hand (FH) technique to perform ultrasound-guided Transversus Abdominis Plane (TAP) nerve blocks. In this prospective, randomized observer-blinded crossover study, 20 adult patients consented to participate prior to undergoing open abdominal surgery in Royal Melbourne Hospital.

David Adams, ACS, RCS, RDCS, FASE, is a highly recognized leader in the field of Cardiac Ultrasound.
In addition to his numerous responsibilities at Duke University Medical Center, he has spent a great
deal of time working on global initiatives to support on-going education and training via mHealth.

Percutaneous drainage is often performed guided by ultrasound (US), which has the advantage of real time images.However, US is unable to visualize structures behind air and bone. The challenges in such areas may be overcome by using image fusion, where a previously recorded CT or MRI examination is co-registered with real time US.

Average block time in the InfinitiPlus™ group decreased by 33%. This difference maybe more apparent in clinicians doing this block less often or by residents since our team was very experienced and working in a large volume hospital.

Ultrasound guidance for regional anesthesia has gained popularity over the last few years.
There is increasing interest in real time ultrasound guidance for neuraxial anesthesia,
especially in patients with technically complex anatomy. Spinal anesthesia can be
challenging in patients with difficult anatomy. Ultrasound guidance for pre procedural marking
have been shown to have promising results.

Currently, facet joint injections are usually performed using CT guidance or fluoroscopy. The use of a GPS enhanced fusion system allows to combine the precision and panoramic view of these imaging modalities with the US dynamic imaging.

Free-hand Ultrasound plays an important role in thyroid diagnostics as a real-time examination, not ionizing and non-invasive, cost effective, ideal also for repetitive followup and able to give information about anatomy, hemodynamics and tissue stiffness, i.e. Elastosonography.

The purpose of our work is to evaluate accuracy, safety, and potential uses of a new needle tracking system when performing US-guided percutaneous procedures that is applicable to commercially available needles.

The purpose of our work is to describe accuracy, safety and potential uses of a new needle tracking system in musculo-skeletal US-guided percutaneous procedures on a biologic model. The ability to guide the needle when performing US-guided needle percutaneous procedures can be easily improved with a short training on a biological model in order to get familiar with the positioning system and to understand the different approaches that can be used to hit the target lesion.

Benign thyroid nodules represent common findings during clinical examination and US evaluation. Basically they do not represent any serious problem for the patient, anyway, sometimes, may require treatment for associated symptoms and/or because of cosmetic problems

The authors describe the use of the Infiniti Plus (CIVCO Medical Solutions, Kalona, IA) needle guidance system in the facilitation of spinal anesthesia in patients with challenging anatomy such as scoliosis, obesity and advanced age.

Dr. Luc Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a 75-year-old woman with previous tonsilar cancer and recurrent right cervical pain, first investigated with a PET/CT. This patient received a cranial base mass biopsy using CIVCO's RAD-GUIDE.

Dr. Luc Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a 63-year-old man with a previous right lobectomy for an adenocarcinoma, referred for a CT guided biopsy using CIVCO's RAD-GUIDE.

Dr. Luc Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a 61-year-old man with a pulmonary cavitary lesion and small mural nodule, referred for a CT guided biopsy of the nodule using CIVCO's RAD-GUIDE.

Dr. Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a Mediastinal Mass Biopsy using CIVCO's RAD-GUIDE on a 53 year old man with an anterior mediastinal mass, referred for percutaneous needle biopsy CT guidance.

Dr. Luc Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a 66-year-old man previously treated for lymphoma, with large pleural and pericardial effusion, received CT guided drainage using CIVCO's RAD-GUIDE.

Dr. Luc Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a brain-dead patient, considered for organ transplant, with a small pulmonary nodule, referred for a CT guided lung biopsy using CIVCO's RAD-GUIDE.

Dr. Luc Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a high risk patient: a 68-year-old man with 3 renal masses, treated with a percutaneous radiofrequency ablation using CIVCO's RAD-GUIDE.

Dr. Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a 66-year-old man with a small renal adenocarcinoma, treated with radiofrequency ablation thermal protection technique using CIVCO's RAD-GUIDE.

Dr. Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a 66-year-old man with left back pain, weight loss, hydronephrosis and several adenopathies; referred for a retroperitoneal biopsy using CIVCO's RAD-GUIDE.

Dr. Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a 63-year-old woman with increasing right back discomfort, hydronephrosis and peri-ureteral infliltration. The Retroperitoneal Infiltration Biopsy is performed using CIVCO's RAD-GUIDE.

Dr. Lacoursière, an Interventional Radiologist of Canada, demonstrates a live case of a 52 year old man with a pelvic peri-diverticular abscess, which is drained using CT guidance and CIVCO's RAD-GUIDE.